Medicare Enrollment Part 1: What every senior needs to know about local coverage

Oct 20, 2023

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By Brian Barta, CPA, William Newton Hospital CEO

Open enrollment for next year’s Medicare coverage is now through December 7. Choosing a health plan that fits your needs is important to having access to local care. If you’re a senior or have a loved one making health plan decisions during this time, William Newton Hospital (WNH) encourages you to review the following information.

Original Medicare has two parts: Part A (hospital insurance) and Part B (medical insurance) and is managed by the federal government. This is the typical Medicare insurance that most are familiar with. WNH finds Original Medicare works very well for our patients. Original Medicare (Parts A & B) is accepted by all WNH facilities, providers, and clinics.

Medicare Advantage (also known as Medicare Part C & usually includes Medicare Part D coverage), is a health plan offered by private insurance companies as an alternative to Original Medicare. It replaces and cancels your Original Medicare plan.

WNH has encountered numerous issues when dealing with Medicare Advantage plans, including excessive prior authorization and medical necessity denials, unnecessarily slow payment from insurers, and inadequate reimbursement rates for the patient services provided. These are issues healthcare providers have struggled with for several years, and the frequency and volume of issues seem to be getting worse.

Further compounding these issues, the number of Medicare Advantage enrollees in the hospital’s service area has increased by over 500% in the last five years. Because of this, William Newton Hospital will no longer be a contracting (in-network) provider for any Medicare Advantage plans in 2024. This situation is not unique to WNH, as numerous providers, hospitals, and healthcare systems across the country have also made the difficult decision to cease contracting with Medicare Advantage plans due to many of the same issues.

We recognize changing insurance options may create a temporary burden for community members who are currently on a Medicare Advantage plan, but we ultimately believe it is the right move for patients and for our hospital and clinics to be sustainable and continue providing care to everyone in our region. I empathize with seniors who are being bombarded by multimillion-dollar marketing campaigns in our state with promises of seamless coverage and numerous additional benefits to entice them to select a Medicare Advantage plan. Still, we urge everyone to be wary and educated consumers when making Medicare coverage elections in this year’s open enrollment period.

Each enrollee must make their own decision based on their personal circumstances. WNH must ensure financial and operational sustainability in order to continue providing essential healthcare services for our entire community, and cannot jeopardize that by continuing to sustain the financial losses for a small segment of our patient population.

If you are already enrolled in a Medicare Advantage plan, you may switch between January 1 and March 31. During this period, you’re allowed to do one of the following things if you’re in a Medicare Advantage plan:

• Switch to another Medicare Advantage plan
• Drop it and go back to Original Medicare, and join a Medicare drug plan (also known as Medigap)

If you need help, we recommend scheduling a free session through your local Council on Aging to visit with a certified Senior Health Insurance Counseling for Kansas (SHICK) health counselor. To help choose the best plan for you, the counselor will evaluate your health needs and medical budget. For Winfield, call 620-221-7020. For Arkansas City, call 620-442-0268. In addition, the Community Health Center in Cowley County has an outreach navigator certified for Medicaid and Marketplace plans. To schedule an appointment, call 620-402-6441.

Editorial Notes: This article was submitted for the "Weekend Check-Up," a regular health column in the Cowley CourierTraveler penned by employees and friends of William Newton Hospital, and is part one of a two-part series. Brian Barta has been serving as CEO at William Newton Hospital since 2022. Prior to being named CEO, he was WNH’s Chief Financial Officer and controller at another Kansas critical access hospital. As a certified public accountant and former financial auditor of hospitals around the state, Barta is an expert world of healthcare finance.